摘要:

AbstractOne hundred patients with cancer were interviewed regarding their attitude to a range of final life events in both their current real and hypothetical future circumstances. Patients who anticipated a future possible role for the more passive options of wishing death to come early or ceasing all treatment, were more hopeless and had a reduced quality of life. Patients however who anticipated a role for the more active options of suicide and/or euthanasia were less fatalistic and did not report a reduced quality of life. The desire for suicide was particularly positively related to younger age, a personal psychiatric past history, and a number of treatment‐related variables reflecting increased patient autonom

ISSN:1057-9249    

DOI:10.1002/pon.2960030103

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractBioethics is the study of moral problems as they relate to health‐care delivery. The Hippocratic Oath laid the foundation of medical ethics as we know it today. Advances in medical technology have moved attention away from traditional ethical concepts, which are now either taken for granted or have been accorded the back seat. Contemporary ethical issues that occupy the minds of ethicists include euthanasia, advance directives,in vitrofertilization, surrogate motherhood and transplantation. Some of these are of less concern in developing countries than in the developed world. In developing countries, the ethics of cross‐cultural research, the ethics of scarcity and sacrifice, and the activities and ethics of multinational companies assume far greater importance. This discussion will concentrate on the ethics and conduct of cross‐cultural research in developing countries. The other important topics of scarcity, sacrifice and multinational activity will be covered elsewhere. Culture is the integrated patterns of human knowledge, beliefs and behaviour of a given community. Culture provides individuals with their identity. To work effectively with people it is necessary to view the world from their perspective. This is particularly important when dealing with people from cultures different from one's own. The world is functionally shrinking and there is interdependence not only in the traditional areas of communication and information transfer but also in the economic, environmental, demographic and migration areas. The concept of ‘global health village’ has now become a reality. In the past, researchers seem to have been motivated to conduct studies in developing countries for a variety of reasons. Whereas some of these are laudable, others are of more dubious ethical implications. This article focuses on issues related to the structural design, process and outcome of such research. Anyone contemplating conducting research in developing countries, especially cross‐cultural research, must keep three main points in mind. In particular, the collective wisdom of both foreign and local investigators should be pooled to determine the appropriate research question(s) relevant to the needs of the target population. If human subjects are required for the study, ethical obligations based on the principle of respect for the person and respect for the autonomy of study subject must prevail. Finally constant checks and balances must be in place to ensure benefit of the research, not only to science and society but to individual subje

ISSN:1057-9249    

DOI:10.1002/pon.2960030104

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractThe meaning and the practice of truth‐telling have undergone many changes throughout western European history. Although Plato noted the conflict between the idea of protecting individuals from information which could frighten them and the idea of respecting their autonomy and freedom to know, Greek physicians displayed a more pragmatic attitude. In contrast, the Catholic church has always condemned any form of lying. The emergence in the Middle Ages of the notion that Catholics had to receive the sacrament of extreme unction in order to ensure salvation made it necessary to inform patients of the approach of death. But the gradual decline of the Church's influence since the eighteenth century led to the increasing practise of telling medical ‘white lies’. Rapid changes are occurring, however, in light of medical progress, evolving ethical beliefs and major sociological changes, especially the increasing role of the media. In fact, the medical ‘secret’ is shared by many people and the problem is no longer whether physicians must tell the truth but how to tell it. Patients often do not understand the information they are given because the words are too esoteric. Failures in physician/patient communication arise also because of the phenomenon of denial, which is a part of the normal adaptation process. The physician has the responsibility of making the decision and of imparting to the patient a sense of innovation and

ISSN:1057-9249    

DOI:10.1002/pon.2960030105

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractLögstrup's ethics were used as a theoretical framework when interpreting 18 nurses' narratives about situations where it had been hard to know what was the right and good thing to do for a cancer patient. The phenomenological hermeneutic interpretation focused on (a) the nurses' experiences of sovereign and perverted utterances of life, ethical demands, interdependence and power; and (b) on the nurses' ways of relating to the ethical dimensions of the situation. In narratives about overwhelming care situations, the nurses did not make a conscious interpretation of whether the patients' demands were also the ethical demands of the situation. In these situations there seemed to be distrust and destructive interdependence between the co‐workers and it was seemingly difficult to be moved by the sovereign utterances of life. In narratives about situations which were possible to grasp, the nurses made a conscious effort to interpret the ethical demands of the situation and acted in accordance with their interpretation until a new interpretation was necessary. The interdependence among the co‐workers was used constructively in order to care for the pat

ISSN:1057-9249    

DOI:10.1002/pon.2960030106

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractPain is one of the major problems in advanced cancer patients. Reports of prevalence studies show an incidence ranging 25–90% in the terminal period (Bonica, 19080). Since the population is aging, the magnitude of this problem is growing large. The problem is greater due to the fact that palliative care is a neglected area; several million cancer patients suffer needlessly every day, making undertreatment of pain an ethical issu

ISSN:1057-9249    

DOI:10.1002/pon.2960030107

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractPatients attending the Royal Marsden Hospital with newly diagnosed cancers or first recurrence were screened for psychological morbidity. A total of 174 patients who met the inclusion criteria were randomly allocated to either adjuvant psychological therapy, a brief, cognitive—behavioural treatment specially designed for cancer patients, or a routine care control. This paper reports the results of the study one year after the baseline assessment. A total of 134 patients completed questionnaires at one year. Patients who received therapy showed significantly less psychological distress measured on the Psychological Adjustment to Illness Scale. There was a tendency for patients in the therapy group to show more change on measures of helplessness and anxiety. Using the criteria for psychological morbidity employed at the time of entry into the study, at one year only 19% of therapy patients were still in the clinical range for anxiety compared with 44% of the control patients; 11% of therapy patients were in the clinical range for depression compared with 18% of the control patients. This study demonstrates that a brief psychological intervention can produce improvement in psychological functioning which persists up to 10 months after the end of the intervention; in particular, the number of patients who would still meet criteria for ‘caseness’ is reduced. These findings justify further investigation of the efficacy of adjuvant psychological therapy in cancer pat

ISSN:1057-9249    

DOI:10.1002/pon.2960030108

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractAn empirical study of 102 families of palliative care patients was undertaken to identify the prevalence of psychological morbidity in family members. Beck Depression Inventory‐derived caseness was identified in one‐half of patients, one‐third of spouses and one‐quarter of offspring, suggesting that psychological distress reverberates substantially throughout the nuclear family. Anger was significantly more common in the offspring, who perceived their families to have poorer communication, cohesion and more conflict than their parents, suggesting that information about the illness may not be adequately transmitted to them. The family as a group is the most appropriate recipient of care, and family meetings are advocated to promote communication, support and mutual unders

ISSN:1057-9249    

DOI:10.1002/pon.2960030109

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractThe patterns of psychotropic medications usage were analysed in 146 cancer patients consecutively referred to an urban psychiatric facility. Antidepressants were prescribed for 67%. Adverse drug reactions (ADRs) were noted in 34%, the commonest ADRs were sedation, dry mouth, restlessness and constipation. The ADRs were selflimiting and tolerable in 16% and severe and intolerable in 17%. Most patients (80%) receiving antidepressants showed a good clinical response in terms of amelioration of psychological symptoms. Most patients found relief from distressing psychological symptoms; the majority did not suffer significant adverse effects.

ISSN:1057-9249    

DOI:10.1002/pon.2960030110

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

摘要:

AbstractCertain peculiarities of a bone marrow transplantation (BMT), between two minor siblings are reconsidered; the recipient a 6.5 year old girl with an adult‐type chronic myeloid leukemia, was an only child, and her parents programmed a second pregnancy hoping that the future brother (sister) could be a compatible donor for BMT.Five years after this unusual and successful BMT, the psychological profiles of the recipient, the donor and their parents are substantially normal. We can therefore consider favourable perspectives for well adjusted and normal relationships among the family members, as well as for the psycho‐intellectual development of these children.Furthermore the re‐evaluation of the ethical questions and doubts concerning this ‘special experience’ suggests that the sons' and parents' rights have been fully

ISSN:1057-9249    

DOI:10.1002/pon.2960030111

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY

ISSN:1057-9249    

DOI:10.1002/pon.2960030112

出版商:John Wiley&Sons, Ltd.    

年代:1994

数据来源: WILEY